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HARRISSONS > Headache > Flashcards

Headache Flashcards

1
Q

Most common cause of Primary headache

A

Tension type 69%

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2
Q

Most common cause of secondary headache

A

Systemic infection 63%

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3
Q

Percentage of tension headache

A

69%

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4
Q

Percentage of headache secondary to systemic infection

A

63%

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5
Q

Percentage of headache secondary to migraine

A

16%

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6
Q

Percentage of headache secondary to IDIOPATHIC STABBING

A

2%

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7
Q

Percentage of headache secondary to CLUSTER HEADACHE

A

0.1%

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8
Q

Percentage of headache secondary to EXERTIONAL HEADACHE

A

1%

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9
Q

Percentage of headache secondary to HEAD INJURY

A

4%

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10
Q

Percentage of headache secondary to SUBARACHNOID HEMORRRHAGE

A

Less than 1%

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11
Q

Percentage of headache secondary to BRAIN TUMOR

A

0.1%

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12
Q

PRIMARY HEADACHES

A
  1. Tension type
  2. Migraine
  3. idiopathic stabbing
  4. EXERTIONAL headache
  5. Cluster headache
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13
Q

Secondary headaches

A
  1. Systemic infection
  2. Head injury
  3. vascular disorders
  4. SAH
  5. BRAIN TUMOR
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14
Q

Primary headaches

A

Headache and its associated features are the disorder in itself

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15
Q

Secondary headache

A

Headaches caused by exogenous disorder

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16
Q

Cranial structures that produce pain

A
  1. SCALP
  2. Middle meningeal artery
  3. Dural sinuses
  4. Falx cerebri
  5. Proximal segments of the large pial arteries
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17
Q

The key structures involved in primary headache

A

Download

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18
Q

Headache symptoms suggesting serious underlying disorder

A
  1. Sudden onset headache
  2. First severe headache
  3. WORST HEADACHE EVER
  4. vomiting that precedes headache
  5. Subacute WORSENING over days or weeks
  6. pain induced by Bending, Lifting and cough
  7. Pain that DISTURBS SLEEP or present immediately upon awakening
  8. Known systemic illness
  9. Onset after AGE 55
  10. Fever or unexplained systemic signs
  11. Abnormal neurological exam
  12. Pain associated with local tenderness (region of temporal area)
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19
Q

When a primary health care physician feels the diagnosis I’d primary headache, it is worth noting that more than ___ % of patients will have “MIGRAINE”

A

90%

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20
Q

Acute severe headache with STIFFNECK AND FEVER

A

Meningitis

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21
Q

LUMBAR PUNCTURE IS MANDATORY

A

Meningitis

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22
Q

There is striking accentuation of pain with EYE MOVEMENT

A

Meningitis

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23
Q

Easily mistaken for MIGRAINE

Cardinal symptoms of POUNDING HEADACHE, PHOTOPHOBIA , nausea and vomiting are present

A

Meningitis

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24
Q

Acute severe headache with STIFFNECK AND “without” FEVER

A

Subarachnoid hemorrhage

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25
Q

May present with headache alone

A

ruptured aneurysm, arteriovenous malformation and intraparenchymal hemorrhage

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26
Q

If the HEMORRRHAGE is small or below the foremen magnum

A

CT SCAN can be normal

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27
Q

True or false:

Lumbar puncture may be required to definitely diagnose subarachnoid hemorrhage

A

True

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28
Q

___% of patients with brain tumor considers headache as chief complain

A

30%

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29
Q

The pain is usually nondescript, intermittent deep dull aching of moderate intensity

A

Headache secondary to Brain tumor

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30
Q

Headache which worsen by exertion or change in position and may be associated with nausea and vomiting

A

BRAIN TUMOR

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31
Q

Th headache of brain tumor disturbs sleep in ____%

A

10%

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32
Q

Brain tumor with Vomiting that precedes the appearance of headache by weeks

A

Posterior fossa brain tumors

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33
Q

Brain tumor with history of amenorrhea or galactorrhea

A

Prolactin secreting pituitary adenoma or PCOS

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34
Q

Headache arising de novo in a patient with known malignancy suggest

A
  1. Cerebral metastases
  2. CARCINOMATOUS MENINGITIS

Or both

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35
Q

Headache appearing abruptly after bending, lifting, or coughing can be due to

A
  1. Posterior fossa mass
  2. Chiari malformation
  3. Low cerebrospinal fluid CSF volume
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36
Q

Annual incidence of TEMPORAL ARTERITIS

A

77 per 100,000 individuals age 50 and older

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37
Q

TEMPORAL ARTERITIS average age of onset

A

70 years old

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38
Q

TEMPORAL ARTERITIS ___% of women prevalence

A

65%

39
Q

Untreated TEMPORAL ARTERITIS develops blindness due to involvement of ophthalmic “artery” and its branches

A

About half of patients

40
Q

Effective in preventing complications if TEMPORAL ARTERITIS

A

GLUCOCORTICOIDS

41
Q

Ischemic optic neuropathy induced by giant cell arteritis is the major cause of rapidly developing bilateral blindness in patients age?

A

> 60 years old

42
Q

Initial management of TEMPORAL ARTERITIS / giant cell arteritis

A

Temporal artery biopsy followed by immediate treatment with PREDNISONE 80mg daily for the 1st 4-6 weeks

43
Q

Headache often starts with severe eye pain often red with a fixed moderately dilated pupil

A

GLAUCOMA

44
Q

Broad diagnosis of chronic daily headache

A

Headache 15 days or more per month

45
Q

___% of population based estimate of adults having daily or near daily headache

A

4%

46
Q

Positional headache- begins when the patient sits or stands upright and resolves upon reclining

A

Low CSF volume HEADACHE

47
Q

Usually occipito-frontal which may not begin at waking hours but worsens during the day

A

Low CSF volume headache

48
Q

Incidence of POST-LUMNAR PUNCTURE headache

A

10-30%

49
Q

Most common cause of low CSF volume headache

A

CSF leak following LP

50
Q

Usually begins 48hours but maybe delayed up to 12 days

A

Post LP headache

51
Q

May provide temporary relief on low CSF volume headache

A

Beverages with CAFFEINE

52
Q

Index events lowers CSF volume or CSF leaks

A
  1. Epidural injection
  2. Valsalva maneuver
  3. Lifting, straining and coughing
  4. Clearing the Eustachian tube in the AirPlain
  5. Multiple orgasms
53
Q

Low CSF pressure

A

Typically: 0-50 mm h20

As high as: 140 mm h20

54
Q

Initial study of choice for CSF LEAK (low CSF volume headache)

A

MRI with GADOLINIUM

55
Q

CSF leak striking pattern in MRI

A

DIFFUSE MENINGEAL ENHANCEMENT

56
Q

Initial treatment CSF leak or low CSF volume

A

BED REST

57
Q

Treatment for patients with persistent low CSF volume

A

IV CAFFEINE - 500mg in 500ml of saline administered over 2 hours

  • ECG DONE first to screen for arrhythmia before administration of IV caffeine
  • at least 2 infusions before doing additional tests
58
Q

If IV caffeine fails

A
  1. Abdominal binder -> AUTOLOGOUS BLOOD PATCH is curative

2. Oral theophylline - for px with intractable pain

59
Q
  • History of general Headache
  • WORST with RECUMBENCY
  • present upon waking and IMPROVES as day goes on
  • Straight forward if with PAPILLEDEMA
  • Visual obscurations are frequent
A

RAISED CSF PRESSURE HEADACHE

60
Q

Initial study of px with RAISED CSF PRESSURE

A

MRI including MR VENOGRAM

61
Q

Diagnostic of raised CSF PRESSURE headache

A

improvement of headache following removal of 20-30ml of CSF

62
Q

Initial treatment of raised CSF pressure

A

ACETAZOLAMIDE 250-500mg BID

63
Q

Next treatment of choice with raised CSF pressure headache

A

TOPIRAMATE

64
Q

TOPIRAMATE MOA

A
  1. Carbonic anhydrase inhibition
  2. Weight loss
  3. Neuronal membrane stabilization (mediated by phosphorylation pathways)
65
Q

Chronic subdural hematoma may mimic this headache

A

POSTRAUMATIC HEADACHE

66
Q

Post traumatic headache treatment

A

Tricyclics antidepressants : AMITRIPTYLINE
ANTICONVULSANTS: TOPIRAMATE, valproate and gabapentin
MOA INHIBITOR “PHENELZINE”

67
Q

Post traumatic headache upon treatment resolves within

A

3-5 years

68
Q

The innervation of the large intracranial vessels and dura matter by the trigeminal nerve

A

Trigeminovascular system

69
Q

Typically presents with headache, polymyalgia rheumatica, jaw claudication, fever and weight loss
*SCALP TENDERNESS

A

Temporal arteritis

70
Q
  • Worst at night and aggravated by exposure to cold

* reddened, tender nodules or red streaking of the skin overlying temporal arteries or less commonly occipital arteries

A

Temporal arteritis/ giant cell

71
Q

Chronic daily headache preventive measures

A

Tricyclics doses up to 1mg/kg with starting dose of 10-25mg daily given 12 hours before the expected time of awakening to avoid excess morning sleepiness

  1. AMITRIPTYLINE
  2. Nortrtyline
  3. Anticonvulsant: TOPIRAMATE, valproate and flunarizine
72
Q

Outpatient approach to manage medication overuse

A

Reduce medication dose by 10% every 1-2 weeks

73
Q

Help relieve residual pain as analgesic is reduced in outpatient

A

NAPROXEN 500mg BID

74
Q

Disease that complicated withdrawal in outpatients

A

DM

75
Q

Drug used for OPIOD Withdrawal symptoms in inpatients

A

CLONIDINE

76
Q

Useful For acute intolerable pain during waking hours in management of medication overuse in inpatients

A

ASPIRIN 1 g IV

77
Q

Useful at night for the management of medication overuse in inpatients

A

IM CHLORPROMAZINE

78
Q

How many days into admission does the effect of withdrawn substance wears off

A

3-5 days

79
Q

After the effect of withdrawn substance wears off, what drugs can be used to induce significant remission

A

IV DHE Dihydroergotamine every 8 hours for 5 consecutive days

80
Q

Drugs required with DHE to prevent significant nausea

A
  1. 5-HT3 antagonist : ondansetron, granisetron, neurokinin receptor antagonist
  2. DOMPERIDONE
81
Q

upper limit Evolution of new daily persistent headache

A

3 days

82
Q

Most serious form of the secondary headache

A

Subarachnoid hemorrhage

83
Q

TCA Antidepressants that Are useful for the management of chronic pain

A

TCA’s particularly NORTRIPTYLINE

DESIPRAMINE

84
Q

Painful conditions that respond to TCA

A 
Postherpetic neuralgia
Diabetic neuropathy 
Tension headache
Migraine headache
Rheumatoid arthritis 
Chronic low back pain
Cancer
Central post stroke pain
85
Q

Non-tricyclics antidepressants block both NE and serotonin reuptake

A

VENLAFAXINE (Effexor)

Duloxetine (Cymbalta)

86
Q

Use primarily for neuropathic pain (trigeminal neuralgia)

A

Anticonvulsants and anti-arrhythmics:
Phenytoin (dilantin)
and carbamazepine (tegretol)

87
Q

Newer Anticonvulsants used for broad ranged neuropathic pains

A

Gabapentin (neurontin)

Pregabalin (lyrica)

88
Q

Orally administered chronic OPIOD medication Used for long term outpatient

A

Levorphanol, methadone, sustained release morphine and transdermal fentanyl

89
Q

Provide immediate relief for postherpetic neuralgia with cutaneous hypersensitivity

A

Lidocaine patches /lidoderm

90
Q

First line drug for neuropathic pain

A

Antidepressants:
NORTRIPTYLINE
DESIPRAMINE

Snri:
Duloxetine
VENLAFAXINE

91
Q

First line In elderly patients with neuropathic pain who require high level mental activity

A

VD

VENLAFAXINE AND DULOXETINE

92
Q

On average, standard doses of mostantihypertensive agents reduce blood pressure by

A

8–10/4–7 mmHg

93
Q

True or false:

Younger patients may be more responsive to beta blockers and ACEIs, whereas patients aged >50 years may be more responsive to diuretics and calcium antagonists.

A

True

HARRISSONS (62 decks)

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